{"id":1544,"date":"2024-03-24T20:16:08","date_gmt":"2024-03-24T20:16:08","guid":{"rendered":"https:\/\/juventudeemtransicao.pt\/?p=1544"},"modified":"2024-03-24T20:25:54","modified_gmt":"2024-03-24T20:25:54","slug":"an-english-ruling-on-transgender-teens-could-have-global-repercussions","status":"publish","type":"post","link":"https:\/\/juventudeemtransicao.pt\/index.php\/2024\/03\/24\/an-english-ruling-on-transgender-teens-could-have-global-repercussions\/","title":{"rendered":"An English Ruling on Transgender Teens Could Have Global Repercussions"},"content":{"rendered":"\t\t
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Artigo original publicado no Economist<\/span><\/h5>\n

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Worries grow over treatments that can leave children sterile<\/strong><\/p>\n

In 2018 Andrea Davidson\u2019s 12-year-old daughter, Meghan, announced she was \u201cdefinitely a boy\u201d. Ms Davidson says her child was never a tomboy but the family doctor congratulated her and asked what pronouns she had chosen, before writing a referral to the British Columbia Children\u2019s Hospital (BCCH). \u201cWe thought we were going to see a psychologist, but it was a nurse and a social worker,\u201d says Ms Davidson (both her and her daughter\u2019s names have been changed). \u201cWithin ten minutes they had offered our child Lupron\u201d\u2014a puberty-blocking drug. \u201cThey brought up the drug directly with our child, in front of us, without discussing it with us privately first.\u201d There was no mention of other mental-health issues, which are known to increase the likelihood of gender dysphoria, the feeling that you are in the wrong body. \u201cThere was no therapy on offer and we were just brushed aside when we raised it.\u201d<\/p>\n

Meghan belongs to a wave of children across the Western world who have identified as transgender in recent years. America had one gender clinic in 2007; now it has more than 50. Piecemeal evidence around the world suggests that three-quarters of children expressing gender dysphoria at such clinics are adolescent girls, whereas until recently it was roughly evenly split. An increasing number are also de-transitioning, choosing to revert to their previous gender. Unfortunately, if children have already begun a medical transition, including hormone treatment, it can leave them infertile and unable to have a full sex life.<\/p>\n

Earlier this month the High Court in London looked at the case of one detransitioner, Keira Bell, who had brought a judicial review against the Tavistock clinic, England\u2019s only specialist youth gender-identity centre. She claimed that the clinic should not have allowed her to take puberty blockers and later undergo testosterone treatment and a double mastectomy. The court ruled that it was \u201chighly unlikely\u201d that a 13-year-old and \u201cdoubtful\u201d that 14- and 15-year-olds are mature enough to consent to such a procedure, and that doctors treating 16- and 17-year-olds may also need to consult a judge before starting.<\/p>\n

Trans activists argue that a long-marginalised group is now finding its voice in popular culture. Their critics retort that vulnerable teenagers are losing themselves in an online world which adulates anyone who comes out as trans. Both could be right. \u201cBeing straight is boring,\u201d says Meghan\u2019s younger sibling.<\/p>\n

Society is struggling to strike a balance. Some children who feel they are in the wrong body will always feel that way and might benefit from altering their bodies. Others will change their minds\u2014many of these will simply turn out to be gay. No medical test can tell these two groups apart. Children with mental-health problems or conditions such as autism are more likely to experience gender dysphoria. Untangling all this is extremely hard.<\/p>\n

However, there are worries that rich countries have the balance wrong. One of the Dutch scholars on whose work the prescribing of hormones and surgery is based has said that her research is being applied to young people for whom it was not designed. And a growing number of people are dissenting.\u00a0The Economist<\/em>\u00a0spoke to more than four dozen people in rich English-speaking countries, including trans people, parents, doctors, social workers, teachers and people who had identified as trans when they were children. Most of those who were critical wanted to be anonymous for fear of losing their jobs or being branded bigots on Twitter.<\/p>\n

\u201cThe first duty of medicine is \u2018Do no harm\u2019,\u201d says a Canadian paediatrician. \u201cIn any other branch of medicine, if you were causing permanent sterility with body-altering surgery and cross-sex hormones, you had better have some pretty strong data…But we\u2019re already going down that road with no strong data at all.\u201d<\/p>\n

To find the best approach will require debate. Some activists do not welcome debate, however. \u201cWe are liberal people,\u201d says Ms Davidson. \u201cBut we are always made to feel like we are right-wing crackpots for raising questions.\u201d<\/p>\n

Crossing a Rubicon<\/h5>\n

Nobody has global statistics for the rate of trans cases among children. Referrals to the Tavistock in London have surged 30-fold in a decade, with 2,700 children referred there last year. Nearly half those referred will start on puberty blockers. In 2019-20, the\u00a0BCCH\u00a0treated 382 patients in its gender clinic, up from 123 in 2016-17. America does not publish statistics. However, in a survey of American high-school students in 2017 by the Centres for Disease Control 1.8% said they were transgender and a further 1.6% said they were unsure.<\/p>\n

The case for puberty blockers is that they can help children with severe gender dysphoria, who feel desperate about developing the \u201cwrong\u201d sex characteristics. That is because the drugs could spare them distress and, potentially, traumatic interventions later: a double mastectomy; a hysterectomy or the shaving of the Adam\u2019s apple.<\/p>\n

Many who go through full medical transition say they are happy with the result. Tru Wilson, who lives in Vancouver, is one. Tru was a gentle boy, and Tru\u2019s parents thought their child might be gay. They then watched a programme together on trans kids and Tru said, \u201cThat\u2019s me!\u201d Tru, now 17, began on blockers at 12, on oestrogen at 14, and is expecting to go through surgery within the next year. \u201cI have zero regrets on how my journey went,\u201d she says. Her father, Garfield, has been impressed by physicians at the BCCH.\u00a0\u201cThere was no pressure pushing us to do anything that we didn\u2019t feel was right for our daughter.\u201d Many other parents also report positive experiences.\u00a0bcch<\/small>\u00a0says that they take the use of puberty blockers seriously and all their patients \u201cgo through rigorous assessments including confirmation that they are capable of considering the benefits and risks\u201d.<\/p>\n

But other transitioners come to see such procedures as a mistake. Claire (not her real name), now a 19-year-old student in Florida, started on testosterone aged 14 because of a loathing for her body. (She was also deeply depressed.) \u201cI felt it was the only option, especially with the insistence that having dysphoria meant you are irrevocably trans and thus you will probably kill yourself if you don\u2019t transition.\u201d Obtaining hormones was easy, she says. \u201cThey pretty much gold-stamped me through.\u201d Then, aged 17, her dysphoria disappeared. \u201cI felt extremely lost. I had never heard of this happening.\u201d She came off testosterone, embraced her identity as a lesbian, and is furious. \u201cIt is the medical industry and the general social attitude towards dysphoric people that failed me.\u201d<\/p>\n

Such \u201cdesistance\u201d appears to be common. At least half a dozen medical studies show that between 61% and 98% of children presenting with gender-related distress were reconciled to their natal sex before adulthood. However, all these studies looked at children with early-onset dysphoria. One recent study on adolescent dysphoria among girls suggested that in many cases it is brought on by the influence of the internet, by female friends who have transitioned and by the miseries of puberty. \u201cWhat is needed is quality research into adolescent-onset dysphoria among girls, and the overlap with autism and mental-health diagnoses,\u201d says Will Malone, an endocrinologist and director at the Society for Evidence-Based Gender Medicine, an international group of doctors and researchers.<\/p>\n

The decision to desist is hardest for those who have received medical treatment. Lisa Marchiano, a Jungian therapist in Philadelphia, counsels several such people. They all believe they were given access to medical interventions too soon. \u201cIt takes enormous strength to admit you have invested so much in a strategy that is a mistake,\u201d she says.<\/p>\n

The evidence in favour of medical treatment is being challenged, too. Arguments for providing hormones and surgery to dysphoric teenagers lean heavily on an intervention approach pioneered in the Netherlands, which has come to be known as \u201cthe Dutch protocol\u201d. This was tested on 55 young people with early-onset dysphoria. The teenagers were treated with puberty blockers, cross-sex hormones and, after they turned 18, surgery. There was no control group. Instead the results of a study of the approach, published in 2014, concluded that these medical interventions were successful on the basis of psychological functioning at least one year after surgery.
The authors warn that their paper contains a small sample, measures only short-term psychological outcomes and has no evaluation of the implications for physical health. One of its researchers, Annelou de Vries, this year published a commentary in\u00a0Pediatrics<\/em>, a medical journal, saying that the approach is being wrongly applied to children (mostly girls) with adolescent-onset dysphoria. She emphasised the need to identify those who need enhanced mental-health support, rather than gender reassignment. Carl Heneghan, a professor at the Centre for Evidence-Based Medicine at Oxford University, wrote last year that use of the Dutch protocol amounts to an \u201cunregulated live experiment on children\u201d. The High Court in England also called such interventions \u201cexperimental\u201d. The flood of hormones in puberty help reconcile a child to their sex in a way that doctors do not fully understand. Blockers stop that.<\/p>\n

No turning back<\/h5>\n

The Tavistock clinic argued that puberty blockers are reversible. That is true up to a point. However, they can affect bone density and so doctors often want to move patients on to cross-sex hormones, which have more permanent effects. The court concluded that blockers almost always lead on to hormones, which carry health risks. Testosterone heightens the chance of heart problems. It leads to vaginal and uterine atrophy which can make a hysterectomy necessary in later life.<\/p>\n

Despite the uncertainties, many doctors have embraced medical intervention. The standard approach used to be \u201cwatchful waiting\u201d, which advocates counselling before moving on to hormones and surgery. However, Joshua Safer of the Mount Sinai Centre for Transgender Medicine and Surgery in New York says puberty blockers are now \u201cthe conservative option\u201d because they allow children time to decide what they want to do. Medical bodies including the World Professional Association for Transgender Health (WPATH) now say that affirming a person\u2019s transgender identity is \u201cinternational best practice\u201d.<\/p>\n

In America intervention was boosted by the Affordable Care Act of 2010, which banned health insurers from discriminating on the basis of sexual orientation and gender identity. In effect, they were thus obliged to cover hormones for people who say they are trans just as they provide contraceptive hormones for women.<\/p>\n

In 2018 the American Association of Pediatrics (AAP) said that all medical evidence supports the \u201caffirmative\u201d approach. But according to a detailed rebuttal by James Cantor, a Canadian sexual-behaviour scientist, none of the 11 academic studies of the subject reaches that conclusion.<\/p>\n

Plenty of doctors fail to observe even\u00a0WPATH\u2019s guidelines. Laura Edwards-Leeper, a professor of psychology at Pacific University in Oregon who helped found America\u2019s first transgender clinic for children and teens in Boston, says she gets many emails from parents \u201cdesperate to find a therapist who will not just blindly affirm that their child is trans\u201d. Ideally, she said, an adolescent with gender dysphoria would have been regularly seeing a therapist, who encouraged them to explore other possible causes for their feelings and had a comprehensive psychological assessment before being put on blockers or hormones. \u201cIt is very rare that even one of these things happens,\u201d she says.<\/p>\n

Schools, the new front line<\/h5>\n

Affirmation in the clinic often echoes affirmation at school. Canada and some Australian states forbid discrimination against anyone on the basis of their self-declared gender identity. The main school programme, taught in British Columbia and Alberta and due to be rolled out across Canada, is called\u00a0SOGI-123. Much of the\u00a0SOGI\u00a0programme is uncontroversial, about being kind and opposing bullying. But critics worry it makes questioning a child\u2019s decisions difficult.<\/p>\n

Pamela Buffone, who runs a website called Canadian Gender Report, says that such programmes attach the concept of \u201cgender identity\u201d (the idea that a biological male can identify as a woman, or a female as a man) to the more familiar concept of \u201csexual orientation\u201d (being gay or straight). In March last year Ms Buffone launched a legal complaint against a school board in Ottawa over a lesson, under a different programme, in which she says her six-year-old daughter was taught that there is no such thing as boys and girls.<\/p>\n

People who support the new curriculum say that it is important to teach trans issues in school just as it is important to teach about race or religion. Glen Hansman, a Canadian teacher who was instrumental in the implementation of\u00a0SOGI,\u00a0says that affirming pronouns and names in schools is \u201cnot a gateway drug to other things\u201d. Vince, an 18-year-old trans boy in rural Canada, (also not his real name) says that SOGI is a lifeline for many young trans people. He wishes the programme had existed in his school, where he says he was assaulted for being gender non-conforming.<\/p>\n

Many legislators, not wanting to look bigoted, are supportive, too. Having seen how the state failed gay people, they are determined that it should not repeat the mistake with trans people. In America Joe Biden has promised to sign the Equality Act into law. That will do a lot to combat widespread discrimination against trans people, such as in housing and the workplace. But it also redefines sex to include gender identity. That could be read to endorse the idea that children should be affirmed in the identity they choose and receive treatment for it\u2014even if that identity may turn out to be temporary.<\/p>\n

In Australia the capital, Canberra, and the state of Queensland have outlawed \u201cconversion therapy\u201d in relation to sexual orientation or gender identity. So too have some American states. Canada is considering a similar law. This conflates two separate issues. Many people would say it is wrong to try to convert gay people into being straight. But the implicit definition of trans conversion therapy risks outlawing any counselling that helps children decide whether their dysphoria is permanent or a phase, and what to do about it.<\/p>\n

A backlash is beginning. In Sweden, after a 1,500% rise in gender dysphoria diagnoses among 13- to 17-year-old girls in 2008-18, more media coverage has focused on the problems of children transitioning. Aleksa Lundberg, an activist, said that she would probably not undergo surgery if she had the same choice today. Referrals of children to gender clinics have fallen by 65% in a year. Finland recently released stricter guidelines, recommending different treatment for early-onset and adolescent-onset dysphoria, and encouraging patients to seek counselling.<\/p>\n

In America trans activists see questions about treatment as political. Chase Strangio, a trans lawyer at the American Civil Liberties Union, tweeted of the English court\u2019s decision: \u201cPlease see this for what it is\u2014an attempt to weaponise our happiness, our hopefulness, and our love of our bodies. This is a dangerous attack on trans survival and it is spreading.\u201d<\/p>\n

Some politicians in conservative American states have drawn up bills that would make it illegal for doctors to prescribe puberty blockers or hormones to children. This is largely an attempt to inflame the culture wars, but it also reflects the worries of some parents.<\/p>\n

Ms Buffone says she raised concerns with her daughter\u2019s school and the local authority. \u201cIt was as though I had left Canada and arrived in some kind of authoritarian state. They said this is what we are doing and it was clear I had no recourse.\u201d Some parents in Quebec, which has its own curriculum, are also objecting. When Catherine, a consultant, asked to see the content of her six-year-old\u2019s sex-education class, the school refused, so she made a freedom-of-information request. It turned out teachers are told that \u201cChildren can begin to explore their gender identity between the ages of 3 and 7\u201d and that sex is \u201cassigned\u201d at birth rather than observed.<\/p>\n

A legal minefield<\/h5>\n

The Australian Family Court has in recent years removed itself from decisions about giving blockers and hormones and even surgery for teenagers, unless parents disagree. Instead, it has recently seen the first case of a child being removed from parents who did not support transition. The ruling was hardly reported in the press.<\/p>\n

Patrick Parkinson, dean of law at the University of Queensland, says Ms Bell\u2019s judgment in England means that such parents will have a basis to oppose their daughter\u2019s removal. He thinks doctors\u2019 claims that puberty blockers are reversible and do no harm have been debunked. \u201cThis is a massive wake-up call for the medical profession in Australia,\u201d he says.<\/p>\n

However for many doctors in transgender clinics in America, the idea of restricting the use of puberty blockers in children is anathema. Johanna Olson-Kennedy of the Centre for Transyouth Health and Development at Children\u2019s Hospital Los Angeles says she mourns the loss of \u201cthis incredible tool\u201d for English children. \u201cI think there is going to be an avalanche of lawsuits,\u201d says Dianna Kenny, recently retired professor of psychology at the University of Sydney. \u201cBut they won\u2019t be in time to save a generation of adolescents who have been wrongly diagnosed as being trans.\u201d<\/p>\n

As for Ms Davidson, daughter Meghan still struggles with depression. However she decided, with her parents, not to take the Lupron. In May, by then 14, she announced: \u201cMum, I\u2019ve decided I\u2019m a girl.\u201d She put on lots of make-up and went to the shopping mall to get her nails painted. But the experience has turned her mother into an activist. She has signed up with\u00a0CAWSBAR,\u00a0a women\u2019s group that advocates for rights to be based on biological sex. \u201cI\u2019m mad as hell,\u201d she says.<\/p>\n

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Artigo original publicado no Economist Este artigo foi publicado na se\u00e7\u00e3o Internacional da edi\u00e7\u00e3o impressa sob o t\u00edtulo “Meninos e meninas” Worries grow over treatments that can leave children sterile In 2018 Andrea Davidson\u2019s 12-year-old daughter, Meghan, announced she was \u201cdefinitely a boy\u201d. Ms Davidson says her child was never a tomboy but the family […]<\/p>\n","protected":false},"author":1,"featured_media":1545,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"elementor_theme","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[10],"tags":[],"class_list":["post-1544","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-internacional"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts\/1544","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/comments?post=1544"}],"version-history":[{"count":10,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts\/1544\/revisions"}],"predecessor-version":[{"id":1555,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/posts\/1544\/revisions\/1555"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/media\/1545"}],"wp:attachment":[{"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/media?parent=1544"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/categories?post=1544"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/juventudeemtransicao.pt\/index.php\/wp-json\/wp\/v2\/tags?post=1544"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}